Active NPI
Ketzia Yahaira Escudero
- Social Worker
- Fairfield, CA
National Provider Identifier
1053930396
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 116623
- Practice address
- 801 Empire St
Fairfield, CA 94533-5702 - Phone
- (707) 425-5744
- Fax
- (707) 425-5162
- NPI assigned
- Apr 15, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 116623 | CA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
801 Empire St
Fairfield, CA 94533-5702
Mailing address
801 Empire St
Fairfield, CA 94533-5702
Phone (707) 425-5744
Other practice location 1
3480 Buskirk Ave Ste 210
Pleasant Hill, CA 94523-4304
Phone (925) 933-2627
Other practice location 2
205 39th St
Richmond, CA 94805-2212
Phone (510) 415-5930
Other practice location 3
2325 Clement Ave Ste A
Alameda, CA 94501-7061
Phone (510) 629-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 116623 | CA | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1586908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774310400000",
"number": "1053930396",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 EMPIRE ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335702",
"telephone_number": "707-425-5744",
"fax_number": "707-425-5162"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "801 EMPIRE ST",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335702",
"telephone_number": "707-425-5744",
"fax_number": "707-425-5162"
}
],
"practiceLocations": [
{
"address_1": "3480 Buskirk Ave Ste 210",
"address_purpose": "LOCATION",
"city": "Pleasant Hill",
"state": "CA",
"postal_code": "945234304",
"country_code": "US",
"telephone_number": "925-933-2627",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "205 39th St",
"address_purpose": "LOCATION",
"city": "Richmond",
"state": "CA",
"postal_code": "948052212",
"country_code": "US",
"telephone_number": "510-415-5930",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2325 Clement Ave Ste A",
"address_purpose": "LOCATION",
"city": "Alameda",
"state": "CA",
"postal_code": "945017061",
"country_code": "US",
"telephone_number": "510-629-6300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ESCUDERO",
"first_name": "KETZIA",
"middle_name": "YAHAIRA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-15",
"last_updated": "2026-03-24",
"certification_date": "2026-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": "116623",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.